How Important is Ketosis?
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| How important is Ketosis to a Low Carb Diet? |
There is an awakening that’s beginning within the low-carb community. It’s an awakening to the realities of Ketosis, it’s importance in weight-loss success, and the rude awakening that we might have somehow deceived ourselves as to what Ketosis actually is and does. While the state of Ketosis is not necessary to achieve a healthy weight, it’s interplay with insulin resistance and fat metabolism is not always understood.
When Dr. Atkins was young, he was one of those kids who could eat anything he wanted and not gain weight. In the early 1960s, however, he found himself with three chins looking 15 years older than he was. That was a critical turning point in his life. He had to face what he’d become: a fat man. Although he knew he needed to do something about his condition, like most of us, he was afraid of being hungry. He didn’t want to reduce his portion sizes and go on a low-calorie diet. He wanted magic.
As a doctor, he knew that hunger was at the foundation for most diet failures. As a cardiologist, his medical training wasn’t in nutrition and metabolism. That allowed him to be more open to the new possibilities he was seeing in the medical literature of that time. In his search for a diet that wouldn’t make him hungry, Atkins ran across a study that suggested a metabolic defect in the way the body handled carbohydrates was the cause for most overweight. This type of diet was called a ketogenic diet.
In the 60s, a few people discovered by accident that carbohydrate restriction worked. Even though cutting back on bread, potatoes and dessert was a popular low-calorie notion at that time, counting carbohydrate grams was relatively new. I can remember the before-and-after-pictures, the convincing advertisements coaxing you to buy the dieter’s secret homemade diet booklet printed off in the garage. They promised you their book was the last diet book you would ever buy. Spiral bound, they were sold through back-of-the-magazine advertisements. I know because I bought one.
What intrigued Atkins in the 60s, however, wasn’t these 60-gram carbohydrate-restricted diets that closely resembled what William Banting did a hundred years prior. What caught Dr. Atkins’ attention was Ketosis. It might surprise you to learn that Dr. Atkins did not actually create his metabolic diet. In fact, one of the scientific papers he looked at during the 60s was a study Dr. Alfred W. Pennington had done for the DuPont company on several of their employees. It was Pennington who came up with the idea that a carbohydrate metabolic defect sat at the heart of overweight and obesity – not Dr. Atkins.
Dr. Walter Lyons Bloom was also doing work during that time that centered on the metabolic changes a carbohydrate-free diet produces. When Dr. Atkins read that the disappearance of hunger that happens a few days into a fast also occurs on a no-carb diet, he was hooked. It was exactly what he was looking for: bacon and eggs for breakfast with plenty of meat and salad for lunch and dinner. So, in 1963, Dr. Atkins tried Dr. Bloom’s no-carb diet, which included checking for ketones in the urine.
At that time, Dr. Atkins did experiment with returning a small amount of carbohydrates to his diet after the zero-carb start. That widened his food choices and made the diet more tolerable. He believed that as long as the urine test strips were turning purple, he was burning his body’s fat stores. Through trial-and-error, he learned that he could eat about 35 to 40 grams of carbohydrates per day and still turn the test strips purple if he added them back gradually enough. That also included an occasional Scotch and water before dinner.
Because of his fear of hunger, he ate several small meals throughout the day. At the end of six weeks, he had lost 28 pounds! That caused some mixed emotions. He felt excited and satisfied with the weight loss, but he also felt resentment towards what he believed was deception by the medical community. What he had discovered was that focusing on calories was not the only way to lose weight, but the idea was a bit obscured because of the effects that Ketosis has on the body.
To him, it felt like he was eating all day long. He ate as much as he wanted to eat and he ate often, so the low-calorie theory had to be wrong. But is it?
Dr. Atkins was not ketone adapted. His body had never used the alternative metabolic pathway before, so it was dumping extremely large amounts of Acetoacetate ketones into his urine. These ketones are not the type of ketones that the brain, kidneys and heart use very well, so the body gets rid of them. Eventually, after adaption, the muscles will convert Acetoacetate ketones into a more usable form and fewer Acetoacetate ketones will be cast off, but initially that doesn’t happen, so weight loss can be rather dramatic.
This early diet that Dr. Atkins presented to the world was a ketogenic diet. It placed the body in a state of Ketosis and kept it producing ketones in the urine as a sign that the body was continuing to mobilize its fat stores. Unlike the 60-gram carbohydrate diets popular during that time, Dr. Atkins’ diet focused on those who were more insulin resistant than those who could lose weight easily at higher carbohydrate intakes. That’s what made his diet different. He cut the carbohydrate sources low enough and added some of them back gradually enough that everyone who tried his diet at that time succeeded.
He believed that the urine test strips coincided with Ketosis. If the diet wasn’t working, you were doing something wrong. He based his opinions on his personal experience, the experience of his co-workers and the experience of his patients at that time. Ketone adaption changes the playing field a little bit, but it doesn’t rule out Dr. Atkins’ belief that we need to stay in Ketosis for the length of the weight-loss period. Since his original diet was ketogenic, it was designed to remain ketogenic. That makes Ketosis extremely important to the diet’s outcome. But why?
Bloom’s diet was only a three-day diet. It wasn’t created to treat insulin resistance. It was a study that was designed to observe the metabolic effects that occur when you cut carbohydrates completely out of your diet. It included bacon and eggs, meat, salad with an oil-and-vinegar dressing, and nothing else. Dr. Atkins took that study diet and added additional no-carb or very low-carb foods in a specific way. The design was perfect. It taught the dieter exactly how many carbohydrates would continue to ensure weight loss. What wasn’t perfect was implementation outside of Dr. Atkins’ office.
Hence, we have a multitude of low-carb dieters today who struggle, stall or give up part way to their goal. That’s the reality without the magic. It also begs the question, “What happened?” There’s more than simple ketone adaption standing in our way. If the Atkins Diet worked in the 70s, why doesn’t it still work today? If Ketosis is essential to success as Dr. Atkins believed, are we even in Ketosis today? Maybe we aren’t. Maybe we just think we are. Maybe we’ve been deceived into thinking that a low-carb diet is always a ketogenic diet.
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